#PLWH

[iamblacbuttafly]

Please consider joining us at one of these events. #plwh #endhivstigma #hiv #transforminghealth #hivawareness #hivpositive #cancer #hsv #diabetes #hivaids #gay #hivprevention #prep #health #covid #aidsawareness #lgbt #worldaidsday #lgbtq #drsebi #hpv #hivtesting #std #hepatitis #herpescure #uequalsu #sexualhealth #stroke #love #lupus (at New Orleans, Louisiana) https://www.instagram.com/p/Ck9ZyK2p5BO/?igshid=NGJjMDIxMWI=

[juniperpublishers-nutrition]

Nutrition And HIV/AIDS: A Qualitative Study on Perceived Factors Affecting Feeding Practices among Adult People Living with HIV/AIDS in Kigali, Rwanda

Abstract

Background: A bidirectional relationship exists between nutrition and HIV/AIDS. Poor nutrition has been associated with unsuppressed viral loads among People Living with HIV/AIDS (PLWH) while HIV infection leads to poor nutrition. HIV treatment, care and support efforts should thus incorporate nutrition management. Despite the fact that various scholars have researched the dietary status of PLWH, there is paucity of explorative research exploring factors that drive feeding practice among adult PLWH. This study therefore aimed to explore the perceptions of PLWH on factors that affect their feeding practices and ultimately dietary diversity.

Methods: Three health facilities were purposively selected as study sites. Interviews were conducted by a trained health professional in a private room at the study sites. Participants were purposively selected for enrolment. Only participants who had recorded a low body mass index (<18.5) were considered for the interview prior to provision of nutrition related routine health education. Sample size was controlled by saturation of information. A pre-tested interview guide was used. The interview guide was developed based on guidelines from WHO and Rwanda National Guidelines for Comprehensive Care of People Living With HIV/AIDS. The conventional content analysis approach was used for the analysis of data.

Results: There were three major themes that emerged from data analysis: knowledge on importance of good nutrition in HIV/AIDS, food availability and, habits and family preferences that affect food intake. The feeding habits of the respondents were guided by their nutritional knowledge, availability of food and also by their habits and family preferences.

Conclusion: There is need for improved health education for PLWH on nutrition challenges associated with HIV/AIDS. The study further underscores the need for nutrition messages that extend to address habitual and family preferences.

Keywords: People living with HIV/AIDS; Nutrition; HIV/AIDS

Abbrevations: PLWH: People Living with HIV

Introduction

In 2016, the United National General Assembly set an ambitious goal to end AIDS epidemic by 2030 [1]. This call has seen many countries, including Rwanda, scaling up interventions that aim to scale up HIV diagnosis, antiretroviral therapy (ART) initiation and care continuum [2]. Not surprisingly, Rwanda has been one of the first countries reported to have reached The Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets [3]. Despite this remarkable progress, UNAIDS, in 2017, there were 940,000 AIDS related deaths globally [4]. With ART coverage well established in most HIV struck regions, HIV researchers have attributed this mortality to the little focus on nutrition related care for people living with HIV/AIDS (PLWH) [5,6].

A bidirectional relationship exists between nutrition and HIV/AIDS [7-9]. Poor nutrition has been associated with unsuppressed viral loads among PLWH [10], while HIV infectionleads to poor nutrition [11,12]. HIV treatment, care and support efforts should thus incorporate nutrition management. As such, global interest in the concept of improving health outcomes for PLWH through proper nutrition has seen a multiorganizational effort including The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), WHO, UNAIDS, and the World Food Program (WFP) [13]. As of 2016, UNAIDS reported the heaviest burden of malnutrition to be in sub-Saharan Africa [14]. Studies measuring impact of malnutrition among PLWH have reported prevalence over 20% [8,15]. Such high prevalence is worrisome as poor dietary diversity has been associated with greater morbidity and mortality among PLWH [16,17].

While dietary status of PLWH has been researched elsewhere [18-21] there is paucity of explorative research exploring factors that drive feeding practice among adult PLWH. The purpose of the current study was to explore perceptions of PLWH on factors that affect their feeding practices and ultimately dietary diversity.

Methods

Study setting, sampling and participant enrolment

Three health facilities were purposively selected as study sites. Interviews were conducted by a trained health professional in a private room at the study sites. Participants were purposively selected for enrolment. Only participants who had recorded a low body mass index (<18.5) were considered for the interview prior to provision of nutrition related routine health education. Sample size was controlled by saturation of information [22].

Ethical considerations

Ethical approval was obtained from University Teaching Hospital of Kigali Ethics Committee (Approval number: EC/ CHUK/0129/2019). All participants signed informed consent prior to being interviewed.

Data collection and analysis

We used a pre-tested interview guide to collect data. The interview guide was developed based on guidelines from WHO [23] and Rwanda National Guidelines for Comprehensive Care of People Living With HIV/AIDS [24]. A survey trained interviewer, GP, conducted the interviews in a private room at the study site. We followed the steps; verbatim transcription, translation, back translation, upload of translated script into NVivo version 12, and reading, coding and narrative presentation of findings. We followed the conventional content analysis approach in analyzing data [25]. With this approach; themes were derived directly from the text data [25].

Results

A total of 15 PLWH were recruited. Out of this total, 7 were recruited from University Teaching Hospital of Kigali, 5 fromKibagabaga Hospital and 3 from Rwanda Military Hospital. Participants were aged between 29 and 52 years. More information on the informants is available on Table 1.

Knowledge on importance of good nutrition for PLWH

Majority of the interviewees demonstrated good knowledge of the importance on nutrition for PLWH. Counselling sessions at time of ART collection was the most cited source of information. ‘‘I know, because we have some food which are important in building our body, for energy and other which protect our body being attacked with some diseases’’ Source: PLH3‘‘…for us because of ARVs we need to eat well and even sufficiently. So that you live long, because to take it [ART] without sufficient food intake it not good as well. So we eat the food that contains all nutritive value like meat, milk, eggs, beans, porridge and others’’ Source: PLWH1

Food availability

Theme two revealed a major barrier was food availability. Interviewees expressed cost as a major factor influencing food availability. Some respondents could only afford certain types of food at certain times of the year where they would be plenty and relatively affordable. Meat was discussed as the most challenging food to obtain for most participants. ‘‘… I tested positive in 2003. At the time, I was living with my family nearby this health facility. There was not treatment that time but later that is when I started collecting have started my treatment in this facility, then as time goes on, this area become very expensive, and I couldn’t be afford to stay around here that why I shifted to Kagugu. So, if to live [rentals] are expensive, it also affects food….’’ Source: PLWH 2‘‘…sadly myhusband passed away, current I am living together with my child, as I said I am not working, therefore to have food is very difficult for us, and end results ARVs affect me in negative way….’’ Source: PLWH4

Habits and family preferences

From theme three, participants described how some habits and family preferences affected their feeding practice. Some participants found it difficult to change their feeding routine to incorporate some foods they normally would not take before being diagnosed with HIV. On the other hand, some participants felt their feeding practice was dependent on their family preferences as they would normally find it hard to have two sets of meals prepared; with one to accommodate their needs. “....my wife has diabetes, so we take different food. I mean she prepares the food different from what I need [as an individual living with HIV/AIDS].” Source: PLWH5“…even before I started taking these pills [ART], fruits were a luxury. I cannot afford to buy fruits so I can consume every day. You can imagine paying 400 Rwandan Francs for one orange. Better I buy one kilogram of Irish potatoes with that money.” Source: PLWH7

Discussion

The main aim of this study was to explore the perceived factors affecting feeding practices among adult people living with HIV/AIDS in Kigali, Rwanda. Based on the findings of the study, there were three main themes emerged. Most participants had good knowledge on importance of good nutrition in HIV/AIDS or were at least aware of the need for good nutrition when living with HIV/AIDS. Food availability and, habits and family preferences emerged as major factors participants perceived affected their feeding practices. These findings underscore the urgent need for renewed focus on nutrition as one of the main components of a comprehensive package of care for individuals who are living with HIV/AIDS [5,6].

Knowledge on importance of good nutrition for PLWH

Based on the findings of the current study, participants demonstrated good knowledge on importance of proper nutrition for PLWH. Counseling sessions at time of ART collection was the most cited source of information. The findings of this study corroborate well with the findings of Anand & Puri [26], which noted that PLWH possessed knowledge concerning nutrition. However, the study noted that most of them did not score very high when it comes to the practices section.

The study noted that while the individuals had proper nutritional knowledge, they did not apply them in their daily practices. The findings of a descriptive study, which was done by Young et al. [27] on nutrition-related knowledge, attitude, and practices (KAP) among individuals who live with HIV/AIDS (PLHIV) in India, demonstrated that while the attitude toward the disease and food was positive, the use of nutritional knowledge was lacking. The findings of the study by Young et al. [27] further noted that the PLWH were having proper knowledge regarding the significance of nutrition during infection.

At the same time, it noted that PLWH had a positive attitude toward the disease as well as the significance of nutrition during the course of the disease. The study further noted that translation of the knowledge into practice was generally low. Therefore, the scholars recommended continuous interventions, which are mainly aimed at behavior change to ensure conversion of the knowledge into healthy dietary practices [27].

This finding points out that knowledge on importance of good nutrition for PLWH is one of the perceived factors, which affects the feeding practices among adult PLWH in Kigali, Rwanda. Good nutritional information for the PLWH plays a key role in improving the overall quality of life of individuals through the provision of the nutrients, which are needed by the body. Besides, it is highly beneficial in keeping individuals’ immune system stronger in such a manner that they are capable of fighting diseases. In addition, through the nutritional information, they are in a position to manage HIV symptoms and complications effectively.

As a result, the government of Rwanda through the relevant authorities should ensure that measures are put in place to ensure that PLWH have access to highly credible nutritional information as it is one of the main perceived factors, which affects the feeding practices among adult people living with HIV/AIDS. Greater financial, political, and technical support ought to be provided to ensure that there are improvements in the quality of nutritional information that is conveyed to PLWH.

Nutrition counseling is a key strategy, which can be used by the government of Rwanda in order to disseminate nutritional information. The relevant authorities can ensure that there is adequate allocation of resources to ensure nutritional counseling it carried out in the right manner. Besides, the healthcare providers should enhance nutrition education to PLWH.

Food availability

From participant responses, an important factor, which affects the feeding practices among adult PLWH in Kigali, is food availability. The findings of the study noted that lack of food is one of the main challenges, which hamper the fight against HIV. Based on the findings of the study, a major concern regarding availability of food was the cost, which is associated with food. The high costs, which are associated with some of the foods hinders some of the PLWH from accessing them. As a result of the costs, affordability of some kinds of foods is notpossible. The findings of the study revealed that meat was the most challenging food to obtain.

The finding of the study is similar to the findings of other studies, which have been carried out by previous scholars. The findings of a number of other studies corroborates well with the findings of the current study. For instance, studies carried out in Mali [28,29], Taiwan [30], Vietnam [31], France [32] and Uganda [33] also concluded that food availability and access is a key factor, which influences the feeding patters of PLWH. The findings of the study noted that lack of some kinds of foods result in poor dietary practices. A separate study that was done by Young et al. [27] noted that food insecurity is one of the key barriers to adherence to care among PLWH.

Similarly, a study, which was carried out by Weiser et al. [34] also noted that there is an inextricably link between food insecurity and the HIV epidemic. Rodas-Moya [35] also carried out a study on the preferences for food and nutritional supplements among adult PLWH in Malawi. The findings of the study illustrated that food insecurity might contribute to intra-household sharing of various nutritional supplements.

Based on the findings of the study, it can clearly be pointed out that food availability affects the feeding practices among adult people living with HIV/AIDS in Kigali, Rwanda.

As a result, the government and the other relevant authorities ought to ensure that there are different kinds of measures in place to ensure that the challenge of food availability is looked into. One of the main measures, which can be put in place, is the development of various national level strategies, which can ensure that food, assistance as well as nutritional support are integrated into the national strategic plan. In addition, the government ought to ensure that the partners, who are involved in food assistance at the community levels, national levels as well as at international levels, are identified.

They can also ensure that a criteria in which foodassistance is offered is properly defined. The government should also define the standards of nutritional support to be provided to the pregnant women, nursing mothers as well as young children with the aim of ensuring prevention of mother to child transmission. The government should also be involved during the development of national policy to guide the community-based organizations, which are willing to offer nutritional support.

The government also needs to ensure that the healthcare facilities are well equipped with the human resources, infrastructure, as well as the supplies, which are needed. Incorporation of nutritional support into HIV/AIDS care always need workers to ensure distribution of adequate food assistance to community-based organizations, clinics, hospitals and schools among others. The government can alsoensure that there are adequate resources to ensure effective transportation of various food supplies and that there is proper storage for the given supplies

Habits and family preferences

Participants highlighted personal habits and family preferences as important factors that affect the feeding practice of PLWH. Based on the findings of the study, a number of the respondents indicated that as a result of HIV, they changed their feeding routine in order to include even foods, which previously they were not taking before being diagnosed with HIV. In addition, there were participants who opined that their feeding practice depended on the preferences of their families.

For instance, some of them previously found it very hard to have two sets of meals prepared; with one to accommodate their needs. The findings of a study that was done by Maertens [36] also noted that one of the main barriers to nutrition management among PLWH is family and personal preference. Based on the findings of the study, most of the patients noted that their attitudes toward changing their diet was brought about by being HIV-positive. At the same time, a number of the participants noted that their preferences for less healthy foods, together with the needs and preferences of their families made management of nutrition to be more challenging on a daily basis. This is similar to the findings of the study, which was carried out by Young et al. [27].

The study therefore notes that the preferences of PLWH for less healthy foods together with their families’ needs and preferences make the management of nutrition to be highly challenging. Measures needs to be put into place to ensure that PLWH are trained on specific nutrition management techniques like shopping, cooking and how they can balance food with illness. The government should also be involved during the development of national policy to guide the community-based organizations, which are willing to offer nutritional support

Conclusion

In PLWH, good nutrition plays a major role in supporting the overall health besides helping to maintain the immune system. At the same time, good nutrition is also highly beneficial for PLWH to maintain a healthy weight. As a result, HIV treatment, care and support efforts should thus incorporate nutrition management. This was a qualitative study based on the perceived factors affecting feeding practices among adult people living with HIV/AIDS in Kigali, Rwanda. It can be concluded that knowledge on the importance of good nutrition in HIV/AIDS, food availability as well as habits and family preferences are some of the main The study concludes that the major perceived factors, which affects feeding practices among adult people living with HIV/AIDS in Kigali, Rwanda include: knowledge on importance of good nutrition in HIV/AIDS, food availability and, habits and family preferences that affect food intake. As a result, the relevant authorities should ensure that there are measures in place aimed at ensuring provision of the right information to the PLWH. PLWH should also get information on how they can balance their food habits and preferences with the illness. The government should also be involved during the development of national policy to guide the community-based organizations, which are willing to offer nutritional support.

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[samdelpapa]

BREVE RAPPORTO DI RICERCA pubblicato: 27 aprile 2022 doi: 10.3389/fpubh.2022.855625 frontiers Frontiere della Sanità Pubblica Controlla gli aggiornamenti TO Distribuzione secondaria dell'HIV Kit di autotest a Sociale e Sessuale Reti di PLWH nel KwaZulu-Natal, Sud Africa. Un breve rapporto Nsika Sithole", Olivier Koole'2, Kombi Sausi", Meighan Krows, Torin Schaafsma", Alastair Van Heerden35, Maryam Shahmanesh5, Heidi van Rooyen95, Connie Celum47, Ruanne V. Barnabas8 e Adrienne E. Shapiro7 Dipartimento di Ricerca Clinica, Africa Health Research Institute, Somkhele, Sud Africa, 2London School of Hygiene and Tropical Medicine, Londra, Regno Unito, "Human Sciences Research Council, Sweetwaters, Sudafrica, Department of Global Health, Università di Washington, Seattle, WA, Stati Uniti, 5MRC/Wits Developmental Pathways for Health Unità di ricerca (DPHRU), Università del Witwatersrand, Johannesburg, Sud Africa, S Institute for Global Health, Università College London, Londra, Regno Unito, 7Dipartimento di Medicina, Divisione di Malattie Infettive, Università di Washington, Seattle, WA, Stati Uniti, # Divisione Malattie Infettive, Massachusetts General Hospital, Boston, MA, Stati Uniti, ° Harvard Medical School, Boston, MA, Stati Uniti ACCESSO LIBERO A cura di: Conserva di Donaldson Fadael, Università George Washington stati Uniti Recensito da: Stefano Okoboi, Università di Makerere, Uganda Shanaz Ghuman, Università di tecnologia di Durban, Sud Africa Sfondo: per raggiungere il 95% delle persone che vivono con HlIV (PLWH) conoscendo il proprio stato di HIV, approcci di test alternativi come l'autotest dell'HIV (HIVST) e il kit HIVST secondario distributior sono necessari. Abbiamo studiato se la distribuzione secondaria del kit HIVST dal maschio e PLWH femminile in Sud Africa porterebbe con successo al test dei loro contatti per HIV e collegamento alle cure se positivo Metodi: PLWH maschio e femmina che partecipano a una sperimentazione di trattamento dell'HIV tra A luglio e novembre 2018 a KwaZulu-Natal, in Sudafrica, è stata offerta la partecipazione come "Distributori di kit HIVST" in un progetto pilota di distribuzione secondaria di kit HIVST da regalare ai sessi C.I https://www.instagram.com/p/Cm0kRytocvU/?igshid=NGJjMDIxMWI=

[biomedres]

The Power and Wisdom of Prevention. Cardiovascular Risk, New Challenge and Approach to PLWH

The Power and Wisdom of Prevention. Cardiovascular Risk, New Challenge and Approach to PLWH Biomedical Journal of Scientific & Technical Research

https://biomedres.us/fulltexts/BJSTR.MS.ID.005808.php

In recent years, quality of life is one of the important points of discussion among specialists working with people living with HIV (PLWH). With the introduction of highly effective antiretroviral therapy (1996), the expectation of life has dramatically increased, and atherosclerotic diseases have become an important cause of morbidity and mortality in people infected with human immunodeficiency virus (HIV). Cardiovascular diseases are the third leading cause of mortality in HIV patients behind non-AIDS-related malignancies and non -AIDS-related infection. One of the many aspects in the treatment of PLWH concerns the prevention of cardiovascular diseases. The absolute risk of developing major cardiovascular disease events (CVD), for example, sudden cardiac death, cardiac arrest, and stroke in HIV-infected patients receiving antiretroviral therapy is still low. However, this risk is increased compared to the risk of uninfected people. This fact is substantially due to a higher prevalence of traditional cardiovascular risk factors that are mostly dependent on the host. Different types of antiretroviral treatment impact differently on metabolic effects and CVD. Prevention of cardiovascular disease in HIV-infected patients is an important goal for a better quality of life. Traditional risk factors should be detected and treated vigorously when possible, to avoid the development of major adverse cardiac events (MACE).

For more articles in Journals on Biomedical Sciences click here

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[cupcake-jme]

#POV - #Woman living with #HIV #AIDS in 2022 💃����🩸🦠 Everywhere I go, every leaflet I open, commercial I see... Everything about #Prep #ART or #LivingWithHiV has a way of making me feel even more #Isolated. Where are the #women and others like me? Information on what it's like specifically dealing with the added complications and health risks of HIV as a #woman?

ENOUGH I say!!!!

💃🏼In 2018, there were 4,106 new AIDS diagnoses (AIDS being the most advanced form of HIV disease) among women, representing 24% of all AIDS diagnoses in that year. An AIDS diagnosis suggests someone who was living with HIV for a long time before being diagnosed or suboptimal engagement in care.

**I was one of those 4,106 women DX'd with AIDS in 2018 and contribute to the 24% AIDS cases**

💃🏼 According to the #CDC Today, of the more than 1.1 million people living with HIV in the U.S., 258,000, or 23%, are women.

💃🏼Women with and at risk for HIV face several challenges to getting the services and information they need, including socio-economic and structural barriers such as poverty, cultural inequities, and intimate partner violence (IPV). In addition, women may place the needs of their families above their own.

💃🏼Women accounted for 19% (7,139) of new HIV diagnoses in 2018, a 24% decrease since 2010.

💃🏼STILL in 2022 you hardly if ever see woman represented anywhere. This. Must. Change. #ThisLooksLikeAJobForMe

"When there's no space for you at the table, create your own."

🙌🏼🤙🏼

#PositivelyMedicated #LiveLifeIrie #CupCake #Advocate #EducateDontHate #KnowYourStatus #UEqualsU #SilenceEqualsDeath #WomanWithHIV #PLWHA #PLWH #Awareness #FYP #Virus #Viral #WomanWithAidsInAnMSMWorld #HIVIsNotACrime #AIDSIsNotADeathSentence

@ejaf @hivisnotacrime

[lacommunarde]

#Repost @lambdalegal (@get_repost) ・・・ Larry Kramer, playwright and fierce AIDS activist known broadly for his work in co-founding GMHC and ACT UP and fundamentally shifting the world's response to the AIDS crisis, has died. "We are facing again a federal government that does not care about LGBT people, people living with HIV or communities of color. Kramer’s passing should serve as a wake-up call and a reminder that righteous anger is an appropriate response when the powers that be fail in their duty to serve all citizens equally and fairly, and we should continue to channel that energy into action until we have won the fight." Read full statement from our CEO, Kevin Jennings, at link in bio. It was an honor for Lambda Legal present Larry Kramer with the Kevin Cathcart Community Legacy Award in 2017. In advertising the event, he requested we use this photo. Rest in power, Larry. Thank you. . . #lgbt #lgbtq #glbt #glbtq #gayrights #transrights #hiv #hivrights #plwh #plwha #aids #hivaids #aidscrisis #actup #actupfightbackendaids #thankyoularry #larrykramer #restinpower #restinpeace #actupny #queerrights #aidscrisis #lgbthistory #gayhistory https://www.instagram.com/p/CAtOmLTMna_/?igshid=110bu0ido0ugq

[viennaenosarts]

If you or anyone you know/love has been diagnosed with HIV, this is for you. Tony very bravely shares his status with the world in an uplifting video and song. End the stigma against people with HIV and AIDS.

[linxlastudy-blog]

At the Watts Health Center to spread the word about LINX LA. Interested to learn if you qualify to earn $130 and receive the tools to thrive in LA as a #PLWH ? Check out our study! https://buff.ly/2IVitNM https://www.instagram.com/p/BxxxXLWgix2/?igshid=xpihh6zwfpwr

[eckva-offical]

wow i cant believe strikethrough is DEAD

We don’t like that word. No one dies here at ECKVA :(

@hextalker

[96thdayofrage]

Knowingly giving AIDS no longer a crime in Illinois

Governor JB Pritzker signed House Bill 1063 into law, ending criminal penalties for those living with HIV in Illinois, effective immediately.

HB 1063 ends criminal penalties against people living with AIDS by amending the Criminal Code of 2012, repealing the statute creating the offense of criminal transmission of HIV,

Pritzker signed the bill on Tuesday, making Illinois the second state in the country to take this action after Texas.

Previously, those living with HIV (PLWH) in Illinois faced the threat of arrest, prosecution, and incarceration even if they did not transmit HIV to another person and would often face longer sentences simply because of their HIV status.

[painmanagementx1]

Pain Management Review

A Recognized Resource of Integrated Pain Management Opinions Authored And Curated By Today's Leaders In Integrated Healthcare Practice. We are a  group of like-minded integrated healthcare professionals developed the Pain Management Review Today online edition to create an easy to use resource to capture medical trends and news as they first start to emerge and how they apply in today’s integrated practice.  We were looking for a better way to organize, vet and easily make public all the updates that were being sent to us on a daily basis.

Our Mission: To provide exemplary and innovative qualified inter-professional medical opinion that improves healthcare team performance leading to healthy patients and communities. 

 Management discussed in these pointers is directed at promoting properly-being and engaging PLWH appropriately in the treatments and rehabilitation interventions, that are supported within the literature for continual, noncancer ache. There are massive limitations in the literature on the management of chronic ache, together with few research conducted in PLWH, heterogeneous diagnostic standards, and high rates of placebo responses that doubtlessly obscure useful treatments.

Unaddressed, opioid-associated constipation can lead to ileus and gastrointestinal obstruction. Nausea or vomiting is one other common medicine side impact that will happen in the first week of opioid remedy however usually resolves because the affected person develops tolerance. Recurrent or persistent nausea and vomiting ought to trigger a second evaluation of the affected person for different causes. Opioid-induced hypogonadism is another opposed effect, and there are no standardized time schedules for screening or monitoring.

Recommendations for the detailed therapy of acute ache are past the scope of this guideline however have been extensively reviewed in other guidelines . Persons residing with HIV and malignant pain must be managed based on cancer pain tips. Chronic ache remains a significant drawback in persons living with human immunodeficiency virus and is related to psychological and practical morbidity, even within the absence of advanced disease problems. Depending on the study, present prevalence estimates of continual ache in PLWH ranges from 39% to 85% [6–thirteen].

Pain is the second commonest symptom in ambulatory settings the place HIV disease is handled. Nearly half of that ache is neuropathic due to harm to the central or peripheral nervous systems from direct viral an infection, infection with secondary pathogens, or unwanted effects of medications . Many other etiologies for neuropathic pain exist outdoors of HIV-related situations . Nonneuropathic ache, such as nociceptive pain, in PLWH is brought on by tissue harm because of irritation , an infection , or neoplasia . Historically, ache among PLWH has been undertreated, significantly amongst girls, individuals with low socioeconomic status, and persons who inject drugs [15–17]. In this context, those who treat patients with HIV must be acquainted with the evaluation and management of continual ache. Although persistent ache administration is acknowledged as a specialty discipline inside medicine, many patients lack access to specialised pain management providers and should depend on their HIV scientific providers to initially consider and handle their continual ache wants.

Women of child-bearing age who are contemplating opioid analgesic remedy must be knowledgeable of the chance of fetal physical dependence and neonatal abstinence syndrome. With the introduction of longer-acting formulations of opioid analgesics, patients could require less frequent administration of quick-release opioids . Scheduled administration of lengthy-appearing brokers maintains plasma concentrations in a therapeutic range, minimizing the frequency of finish-of-dose failures or withdrawal symptoms.

Nonpharmacologic remedy and nonopioid pharmacologic remedy are most popular for continual pain. Clinicians should think about opioid therapy provided that anticipated benefits for both pain and function are anticipated to outweigh dangers to the affected person. If opioids are used, they need to be combined with nonpharmacologic therapy and nonopioid pharmacologic therapy, as acceptable. One study found no variations between extra liberal dose escalation and upkeep of current doses after 12 months40; evidence on different comparisons associated to opioid dosing methods was too restricted to find out results on outcomes. The review also considered proof related to initiation and titration, harms and adverse events, and risk mitigation. Because long-term opioid use could also be affected by use of opioids for acute ache, CDC added a medical query on the effects of prescribing opioids for acute ache on long-time period use . The guideline is intended to enhance communication about benefits and risks of opioids for persistent pain, enhance safety and effectiveness of ache remedy, and cut back risks associated with long-time period opioid therapy.

Clinicians ought to evaluate PDMP data when beginning opioid therapy for persistent pain and periodically throughout opioid therapy for continual ache, starting from every prescription to each three months. Clinicians should evaluate advantages and harms with sufferers within 1 to 4 weeks of beginning opioid therapy for continual pain or of dose escalation. Clinicians should consider advantages and harms of continued remedy with sufferers every 3 months or extra incessantly. If advantages do not outweigh harms of continued opioid therapy, clinicians ought to optimize therapies and work with sufferers to taper opioids to lower dosages or to taper and discontinue opioids.

Surveys of sufferers of unknown HIV status with chronic, noncancer pain have proven that around-the-clock pain aid with transdermal fentanyl and extended-release morphine resulted in a better high quality of life . In a systematic evaluation revealed in 2015, Santos and colleagues examined using tapentadol in comparison with oxycodone for the therapy of chronic musculoskeletal pain in 4 randomized, controlled trials with a complete of 4094 patients . While the authors found that extended-launch tapentadol lowered pain more than placebo and controlled-launched oxycodone, the medical significance was unsure due to high dropout rates, lack of information for the first end result in some studies, and use of baseline-statement-carried-ahead for imputed data evaluation. Medical suppliers ought to perceive the essential ideas of pain administration, including when particular therapies should be really helpful, their potential risks and benefits, and the opposed drug reactions and drug–drug interactions that can happen when pharmacotherapies are prescribed. Medical suppliers should preserve a nonjudgmental perspective and broad differential diagnosis when managing unexpected affected person behaviors. For instance, the phenomenon of “pseudo-habit” may clarify the habits of sufferers who seem like hoarding their medicines or requesting early refills.

Just as with most cancers sufferers, pain management is an essential component of overall disease administration for PLWH . Pain has always been an essential a part of human immunodeficiency virus illness and its expertise for sufferers. In this guideline, we review the kinds of chronic pain commonly seen among individuals dwelling with HIV and evaluation the restricted evidence base for remedy of chronic noncancer ache on this population. We additionally review the management of continual pain in special populations of PLWH, together with persons with substance use and psychological health issues. Finally, a basic evaluation of attainable pharmacokinetic interactions is included to assist the HIV clinician within the treatment of continual ache in this population. Clinicians should review the patient’s history of managed substance prescriptions utilizing state prescription drug monitoring program knowledge to determine whether the affected person is receiving opioid dosages or harmful mixtures that put him or her at excessive threat for overdose.

[md-admissions]

Hi. Can I ask what you think to the term IVDU or ex-IVDU being printed on surgery lists for staff? We often have notations made for us, about weight (need other equipment) or history (need post op breathing treatments) and I often wonder how patient centred that is. No one really judges. We use this info to assess a situation. But from an outside perspective is is rude, unfeeling? Uncaring? Thanks.

Great question!

So I made an transition away from the term IVDU in documentation of all forms. And I think it makes a lot of sense for practical and professional reasons.

1. IVDU= Intravenous Drug User; as discussed, ‘user’ is not great terminology. “Drug user” is a judgment-ladened term that really only serves to diminish the care we provide and stigmatizes patients.  We should all work on phasing this out.

2. IVDU is outdated. We also have, as espoused by the CDC and multiple other specialty societies, a newer term: PWID (person who injects drugs) which is similar to the term PLWH (person living with HIV). It is not a value judgement and gets the point across in a short acronym as well.

3. From an operational standpoint: IVDU provides very little information. Heroin and meth can both be injected. Either one is managed differently from a medical and anesthesia standpoint. OUD (opioid use disorder) is more specific, “PWID (insert name of drug)” is another more medically useful and helpful way to impart information on the list. And as those of us in training or have trained all know, the one-liner is where only the most important information shows up. So let’s make every character, every word provide helpful information.

4. What information is the phrase ‘ex-IVDU’ actually providing in a situation assessment? One of my favorite attendings once challenged me when I said ex-IVDU at the start of my fellowship, asking: “When you say that, what does it tell me or the team consulting you?” And I thought about it. And thought about it. My conclusion? It provided...really nothing. 

It does not address what we actually wanted to know: did the injection of drugs lead to medical or surgical complications that inform the current hospitalization or clinical presentation.  It says nothing about when the injecting stopped. Ex-, what does it mean? Stopped two days ago? Two weeks ago? Two years ago? Twenty years ago? The temporality is perhaps more important than the exposure itself. Many people have injected drugs in the past but have not required medical attention, hospitalization, or have lead to addiction. If there have been no complications with lasting mortality or morbidity outcomes pertinent to the patient’s current hospitalization or active medical/surgical issues, what is the value of putting that in the one liner, where only the most important information needs to be present? 

One-liners on a sign-out sheet or rounding sheet take up valuable real estate. Let’s be mindful about putting only the truly relevant into them for the sake of ourselves, our colleagues, and our patients.

5. ‘No one really judges.’ I would just add to that statement, to paraphrase from the episode on Queer Eye when the Fab 5 makeover their first trans male client ‘No one really judges...that you know of.’ And of course I do not mean a pointed ‘you’, anon. I mean the general you. Us. I think that’s something we as young physicians and healthcare professionals need to remember. That we know of. Our colleagues do not all hold the same values as we do, and many (sometimes even ourselves) refrain from speaking up because of the rigid hierarchy that exists in medicine and surgery. 

6. The outside and inside perspective is that IVDU is a term we should all transition away from. Physicians are humans. There are practicing physicians who have struggled with addiction, are struggling currently with addiction, have injected drugs before, etc. What do they hear when they hear their own colleagues, supposedly people on their side, say these terms or type these terms so casually? It hurts. The presence of the words unto themselves tells them that the human struggles they have faced are not acknowledged or respected and that they are seen as deficient, broken, not worthy. That’s how our patients feel, too, when they hear or see that verbage. So don’t just do it for the patients who will never see your sheet. Change the language for those around you who you’ll never know are impacted by those words.

Thank you for the excellent ask!

md-a

[dfwnews]

The state of HIV and aging

The state of HIV and aging

PLWH are living longer, but stigma remains a big issue By now we’ve all heard the statistics: 50 percent of people living with HIV (PLWH) are over the age of 50, and by 2030 it will be 70 percent. When we talk about HIV and aging it always tends to sound like a laundry list of everything that can possibly go wrong as we get older. But please indulge this old-timer as I ponder a few things for us…

[hivdoctorsindelhi]

HIV Specialists in Delhi Book Instant Appointment

Once you find out you have HIV Doctors near me, your life might not be the same. You may encounter many challenging situations in life; thoughts of fear, sadness, or anger may preoccupy your thoughts. Just keep in mind that this is normal and a necessary element of adjusting to such a drastically altering circumstance. With the correct support and care, you can still lead a long, happy, and fulfilling life even after contracting HIV. Since technology has advanced, people with HIV can now expect to live as long as the ordinary person. Due to widespread misunderstandings regarding HIV, the method of diagnosis and treatment has a significant impact on how one move ahead.

CD4+ T-cell depletion, immunological activation, and inflammation are symptoms of HIV infection-related immune homeostasis disturbances. In HIV-positive individuals, effective antiretroviral therapy (ART) does not completely restore immunologic and clinical health (PLWH). Their immunological health and CD4+ T-cell counts have been improved with a variety of medicines, but no treatment has been proven to be efficient. Here, we perform a comprehensive review and meta-analysis of the clinical studies that have been conducted so far on methods to increase CD4+ T-cell count while reducing immunological activation and inflammation.

Methods: We searched five electronic databases for potentially pertinent articles and chose studies that met our eligibility criteria. These studies had to address the effects of medical treatment on inflammation, immunological activation, and CD4+ T-cell count recovery with or without ART. We focused especially on immunologic non-responders who had a successful treatment plan.

Results: The systematic review and meta-analysis included thirty-three papers. There were, however, no proven safe and efficient treatments for enhancing CD4+ T-cell reconstitution. The safety, dosage, and duration of the candidate pharmaceutical use, as well as whether it is taken with ART, are the primary factors that determine the immunological benefits or adverse events.

Therapy for HIV

HIV has the potential to gradually weaken the immune system and progress to AIDS. Having HIV does not automatically indicate you have AIDS because AIDS is the last stage of the illness. Occasionally, it might be in the early stages, and with the right care, it could be prevented from developing into AIDS.

What does it serve?

Using a CD4 count, one can:

See how your immune system is being impacted by HIV. This can assist your doctor in determining whether you are more likely to develop disease-related problems.

Choose whether to begin or modify your HIV medication.

Detect AIDS (acquired immunodeficiency syndrome)

The same illness is referred to by both the designations HIV and AIDS. However, the majority of HIV-positive individuals do not have AIDS. When your CD4 count is severely low, AIDS is identified.

The most severe HIV infection is AIDS. The immune system is severely harmed, and opportunistic infections may result. These are dangerous, frequently fatal illnesses that prey on much weakened immune systems.

If you've undergone an organ transplant, you could additionally require a CD4 count. Patients receiving organ transplants receive specialized medications to ensure that their immune systems won't fight the new organ. A low CD4 level for these patients is positive and indicates that the treatment is effective.

How Does a CD4 Count Work?

A tiny needle will be used by a medical practitioner to draw blood from a vein in your arm. A small amount of blood will be collected into a test tube or vial once the needle has been placed. The needle may sting somewhat when it enters or exits your body. Usually, this only needs a few minutes.

Will There Be Anything I need to do to get ready for The Test?

For a CD4 count, no special preparations are required.

Does The Test Involve Any Risks?

The danger of getting a blood test is extremely low. Even though you can have some minor discomfort or bruising where the needle was inserted, most side effects are transient.

What Do The Findings Indicate?

The number of cells per cubic millimeter of blood used to represent CD4 findings. There is a list of typical outcomes below. Your health and even the lab that conducted the test could affect your results. Speak with your healthcare professional if you have any queries regarding your results.

500 to 1,200 cells per cubic millimeter is typical.

250–500 cells per cubic millimeter are abnormal. It implies that you might be HIV-positive and that your immune system is compromised.

200 or fewer cells per cubic millimeter are abnormal. It suggests AIDS and a significant risk of opportunistic infections that could be fatal.

While there is currently no treatment for HIV, there are a number of medications you can take to boost your immune system and fend against AIDS. Today, HIV-positive individuals enjoy longer lifespan and higher quality of life than ever before. Regular visits to your doctor are crucial if you have HIV and are living with it.

   Dr. Raina’s Safe Hands Clinic

Dr. Vinod Raina HIV Doctors in Nehru Place

Contact Us-9136363692|9871605858

Address: — Saket E-34, Ekta Apartments near

Malviya Nagar Metro Station Gate No-4 New Delhi-110017